Provider Demographics
NPI:1194725697
Name:FLANAGAN, TERESA ANN (LPCC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 QUAPAW ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3587
Mailing Address - Country:US
Mailing Address - Phone:505-231-6523
Mailing Address - Fax:
Practice Address - Street 1:1924 QUAPAW ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3587
Practice Address - Country:US
Practice Address - Phone:505-465-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0195991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53031768Medicaid